70岁以上中危非ST段抬高型ACS患者不同时间窗介入干预的疗效  

Effects of percutaneous coronary intervention at different therapy time on patients at 70 years or elder with non-ST-elevation acute coronary syndrome in intermediate-risk

作　　者：余晓凡[1] 余华[1] 陈鸿武[1] 冯克福[1] 胡昊[1] 周俊岭[1] 孔祥勇[1] 余东彪[1] 吴佳纬 李龙伟[1] 马礼坤[1] 

机构地区：[1]安徽省立医院心血管内科,合肥230001

出　　处：《临床心血管病杂志》2017年第4期314-318,共5页Journal of Clinical Cardiology

基　　金：安徽省公益性技术应用研究联动计划(No:15011d04032);安徽省科技攻关计划(No:1604a0802074)

摘　　要：目的:观察老年中危非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者不同介入治疗时机的临床预后。方法:本研究为回顾性研究,按照2015年欧洲NSTE-ACS管理指南评判中危NSTE-ACS风险标准,连续纳入本院2010-01-2013-06成功行经皮冠状动脉介入(PCI)治疗的老年中危NSTE-ACS患者599例,根据入院后不同介入治疗时间分为入院后24h内介入组(195例)、24~72h内介入组(234例)和72h后介入组(170例)。主要临床终点为PCI术后3年随访期间包括心性死亡和心肌梗死、靶血管血运重建(TVR)在内的主要心血管不良事件(MACE)的发生情况。结果:入院后24h内介入组、24~72h介入组、72h后介入组3年MACE的发生率分别是11.4%、9.5%和23.7%(P=0.001),进一步利用多因素Cox回归分析显示24h内介入组患者MACE的发生率低于72h后介入组(OR:0.645,95%CI:0.437~0.963,P=0.021),24~72h介入组患者MACE的发生率低于72h后介入组(OR:0.372,95%CI:0.217~0.637,P=0.001),而24~72h介入组MACE的发生率与24h内介入组未见明显差异(OR:0.712,95%CI:0.386~1.313,P=0.276)。结论:对于老年中危NSTE-ACS患者,入院后72h内较72h后干预可以减少患者MACE的发生率。Objective：To explore the optimal time of intervention in elderly patients with non-ST-elevation acute coronary syndrome（NSTE-ACS）in intermediate-risk.Method：This was a retrospective clinical study.We analyzed data of 599NSTE-ACS patients（aged≥70years）who were underwent PCI in our hospital between January,2010 and June,2013.Patients were stratified into three groups according to their timing of invasive strategy.The 195 patients received intervention treatment within 24 hours of hospital admission;234patients received intervention treatment ranged from 24 to 72hours of hospital admission;170patients received intervention treatment after 72 hours of hospital admission.The primary endpoint was major adverse cardiovascular events（MACE）,a composite of cardiac death、myocardial infarction or target vessel revascularization（TVR）at 3years.Result：MACE rates at 3years were 11.4%,9.5% and 23.7%（P=0.001）in PCI within 24 hours,24-72 hours,after 72 hours group respectively.Multivariate analysis confirmed that patients who received intervention therapy within 24hours（OR：0.645,95%CI：0.437-0.963,P=0.021）and from 24 to 72hours（OR：0.372,95%CI：0.217-0.637,P=0.001）had lower 3-year MACE rates than the patients who received intervention therapy after 72 hours.But the 3-year MACE rates were similar between patients who received intervention therapy within 24 hours and at 24-72hours（OR：0.712,95%CI：0.386-1.313,P=0.276）.Conclusion：Invasive strategy（72h）can improve clinical prognosis in elderly patients with NSTE-ACS in intermediate-risk.

关 键 词：老年 非ST段抬高急性冠状动脉综合征 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]